Summary & Overview
HCPCS Level II A9543: Yttrium Y-90 Ibritumomab Tiuxetan, Therapeutic Dose
HCPCS Level II code A9543 denotes a therapeutic radiopharmaceutical dose of yttrium y-90 ibritumomab tiuxetan, used in systemic radioimmunotherapy. This code matters nationally due to the high-cost, specialized nature of radiopharmaceutical cancer therapies and the need for standardized billing across hospital outpatient departments and specialized oncology infusion centers. Payers commonly involved in coverage and reimbursement decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find an analysis of clinical context, typical sites of service, and the service type tied to this therapeutic radiopharmaceutical. The publication outlines benchmarks and coverage considerations relevant to major national payers, highlights billing and service-line implications for oncology and radiation therapy departments, and summarizes policy and coding issues that affect utilization and reimbursement. Where specific input data was not provided, the publication notes the absence of that information. The focus is national; no state-level specifics are included.
Billing Code Overview
HCPCS Level II code A9543 represents yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries. This code is used to bill for a radiopharmaceutical therapeutic dose of yttrium-90 labeled ibritumomab tiuxetan intended for systemic radioimmunotherapy.
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Service type: Radiopharmaceutical therapeutic dose
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Typical site of service: Hospital outpatient department or specialized infusion/radiation oncology center
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 60–75-year-old with relapsed or refractory CD20-positive B-cell non-Hodgkin lymphoma who has failed prior chemotherapy and rituximab-containing regimens. The multidisciplinary workflow begins with hematology/oncology evaluation, confirmation of CD20 expression, baseline labs (CBC, chemistry, renal and hepatic panels), and imaging (PET/CT) to document disease extent. The patient receives pre-therapy rituximab infusion to clear circulating B cells, followed by dosimetric and therapeutic preparations. On the treatment day, nuclear medicine or radiation oncology staff verify the calculated therapeutic activity (up to 40 millicuries) of A9543 (yttrium-90 ibritumomab tiuxetan), obtain informed consent, and perform radiation safety checks. The therapeutic dose is administered intravenously under monitored conditions with nursing and physician oversight. Post-infusion monitoring includes observation for infusion reactions, serial blood counts over subsequent weeks to months to monitor for cytopenias, and outpatient follow-up with the hematologist/oncologist and radiation safety officer. Typical sites of service are hospital outpatient infusion centers, specialized cancer centers, or ambulatory infusion suites with nuclear medicine capabilities. Billing uses A9543 for the therapeutic dose component; associated professional services and facility services are reported separately using appropriate CPT and revenue codes.
Coding Specifications
| Modifier | Description | When to Use |
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